- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,370.32 / $10,232.93
| Facility | | $1,862.09 | $5,370.32 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $575.44 / $1,862.09
| Professional | | $316.23 | $575.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $354.81 / $416.87
| Professional | | $177.83 | $354.81 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $630.96 / $1,318.26
| Professional | | $338.84 | $630.96 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,023.29
| Professional | | $512.86 | $741.31 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,248.07 / $8,317.64
| Facility | | $3,388.44 | $5,248.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $616.60 / $1,737.80
| Professional | | $288.40 | $616.60 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $8,511.38
| Facility | | $2,570.40 | $5,128.61 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $524.81 / $1,148.15
| Professional | | $281.84 | $524.81 | $1,148.15 |